Healthcare Provider Details

I. General information

NPI: 1316876543
Provider Name (Legal Business Name): PHARAOH'S TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 LEE RD
SHAKER HEIGHTS OH
44120-5108
US

IV. Provider business mailing address

10545 REMINGTON AVE
CLEVELAND OH
44108-1320
US

V. Phone/Fax

Practice location:
  • Phone: 216-716-8696
  • Fax: 216-472-8565
Mailing address:
  • Phone: 216-250-4812
  • Fax: 216-472-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLIUS DE'AUNTE VINCENT BOYD
Title or Position: OWNER
Credential:
Phone: 216-250-4812